The transfer of responsibility for public health to local government earlier this year was a momentous change, particularly for the individuals at the helm. As part of its drive to develop managerial leadership skills Solace recently spoke to two directors of public health about their views of leadership in local authorities.
Dr Jane Moore was appointed director of public health for Coventry city council in 2012
"I have worked in more than one PCT, with several councils and in the Department of Health, and leadership is different everywhere. It's all about adapting.
"For one thing, councils work across a lot more agencies, so we have to use multiple approaches with lots of different stakeholders. I'd describe it as 'matrix working': leaders have to have the skills to release potential because we are relying on colleagues and communities and the public themselves to be willing and able to work with us.
"We are just emerging now from the transition period when public health first came under the local government banner. My team is about the same size as it was in the NHS but it isn't enough now just to have technical expertise – public health professionals need to become external-facing relationship managers.
"Communication is a key skill, leaders need to work with people and support them, recognising opportunities elsewhere in the council and within other stakeholders where there may be health and well-being benefits. We have started making those connections but we need to do more of this to take full advantage of the opportunities. We need to see ourselves as catalysts to improve public health through other people, and build relationships so that individuals elsewhere in the system become champions for public health. This will mean working differently with others and being prepared to lend our skills to other people's work areas.
"Current health and social care services are not sustainable given the cuts in public funding and we have to acknowledge this and look to benefit from what real integration could achieve across health and social care. This makes it crucial that through effective engagement leaders motivate people across the voluntary sector, the NHS and in the council to act and help us to drive change. We also need to recognise more clearly the role of people and communities themselves in delivering change. There is a definite need to work differently with communities and build their strengths. We have to look for wins that both communities and services own. This asset-based approach also gives us new ways of looking at service integration.
"Coventry is one of seven UK upper tier authorities in the UK Marmot Network, which means there is a huge impetus to tackle the inequalities which contribute to ill health. There is a drive for every directorate to look at how it is using the areas of work it is already undertaking to address health issues, and cross-council conversations are already taking place. Marmot is really helping the integration of public health into local government, and it is great to see such strong support for this initiative not just from our council Leader but also from both the majority party and the opposition. There is lots of enthusiasm here for making a difference, and I like that."
Dr Melanie Smith joined Brent council in 2013
"Since directors of public health have moved from the NHS into councils I think our personal leadership qualities have become even more valuable. The role was an established position in the NHS and irrespective of who was in the post, their positional authority was, to a greater or lesser extent, a given. Local authorities are much bigger organisations than we are used to working in so it is more important than ever that we are visible and make contact with a wide range of council staff. From members and directors to front-line staff we need to learn their language and use it.
"The NHS is a more homogenous environment than local government. Different councils share some commonality but all have different personalities, so leaders need to be flexible and have the ability to draw on a variety of ways of working. I manage a core team here at Brent with dispersed public health professionals in other departments and I am already learning that although I directly manage a smaller team than in the NHS, I potentially have a much bigger virtual team if I can mobilise staff in other parts of the council.
"The vision here isn't to just add a public health team to the council, but for the council to become a public health organisation across the full range of its functions. The ability to work through other people is a key leadership skill because of the council's different activities having such a potential influence on the health of the population it serves. I think people who are drawn to being public health leaders are happy to have indirect influence and we develop the ability to advocate and persuade others through both our training and our professional experience.
"Public health people get up in the morning to improve public health; other council colleagues get up in the morning to improve community safety or neighbourhood parks for example, but all these things can influence health so we need to find the levers to enable colleagues to achieve their objectives and improve health at the same time.
"It is very important to support staff working in other environments and help them to do their jobs better: the public health 'call to action' should be a complementary not a conflicting call on their time. Public health leaders have brought a different and new set of knowledge to local authorities – not least about the evidence of what improves or damages health, and this helps us prioritise. For example, we know that social isolation has a negative impact on physical and mental health, so we need to make the case to our community safety colleagues that by making neighbourhoods safer they are enabling people to integrate more and so become healthier.
"As well as council colleagues, public health leaders need to work with many partner organisations, from the police to faith communities to local businesses. The NHS doesn't necessarily have strong relationships with non health partners, one of the welcome aspects of coming into local government is the range of partnerships the Council has, on which public health can 'piggy-back', we don't have to invent it all ourselves.
"Another part of my role is to access and interpret technical information such as scientific reports and translate it into a form accessible to non-experts, to ensure members are fully informed and in a position to take decisions. It is therefore critical for the director of public health to establish and maintain their personal credibility and be seen to provide advice that members can rely on."
To find out more about Solace go to the new website www.solace.org.uk
